New grad in peds CVICU

[mysonsmama]

So I just accepted a position at a children's hospital in their CVICU. I was wondering if we have any experienced CVICU nurses here that could give me any pointers as far as common meds and cardiac abnormalities/admitting diagnosis for me to research in the coming weeks before I start.

Thanks!

[meanmaryjean, DNP, RN]

Start with the hypoplastic left and right heart defects, tetralogy of Fallot, transposition of the great vessels and truncus arteriosus. A good understanding of the pressures within the heart and how pulmonary hypertension manifests with various defects should keep you busy a good long while!

[FlyingScot, RN]

Also learn and really get a handle on "ductal dependent" lesions as well as pre and post-ductal pulse oximetry.

[NotReady4PrimeTime, RN]

What meanmaryjean said! You probably won't be assigned any of those kids immediately post-op for the first while but you'll get them a few days later. cincinnatichildrens.org has a great animated section for cardiac defects that really helps understand the various circulation patterns and how they change with surgical repair. You might want to check it out. Heart Encyclopedia | Cincinnati Children’s

As for drugs, the list is long! Here's a partial list for you (in no particular order):

Epinephrine

Norepinephrine

Milrinone

Amiodarone

Adenosine

Atropine

Amlodipine

Nicardipine

Nifedipine

Prostaglandin E

Epoprostenol

Dopamine

Dobutamine

Sotalol

Propranolol

Heparin

Enoxaparin

Sildenafil

Tadalafil

Bosentan

Ambrisentan

The first four are the ones you'll see most often, unless your unit also admits neonates pre-op, then you can add prostaglandin E. The learning curve will be steep, so you're wise to be looking ahead.

[mysonsmama]

Thanks for the replies! We do have neonate, unsure about pre-op however.

I definitely have my work cut out for me but I am so excited.

[meraki86]

This is my current field! You will love it. The learning curve is very steep and no two hearts are ever the same. About ductal dependent lesions - know if your defect is ductal dependent for PULMONARY vs SYSTEMIC blood flow. This is extremely important. If you have the time, draw out a normal heart vs your patient's defect vs repaired heart. Seeing where the blood flows is very helpful. There is also a book called Pediatric Cardiac Intensive Care Handbook (there's an ebook version too). I have it on my Ipad with me at work. It is a great resource to have with explanations of the defect, arrhythmias, echos, illustrations, etc.

Good Luck and let us know if you have more questions!

[NotReady4PrimeTime, RN]

Don't put too much pressure on yourself. They're not going to expect you to arrive fully prepared to run an ECMO circuit! You'll be provided an orientation and phased education so you're properly prepared to care for these tiny people. Many PCICU patients will be neonates, but not all. Older kids will be back for reop - Fontans, RV-to-PA conduits, valves, pacemakers. Then there are the athletes with undiagnosed long QT, the toddlers with myocarditis or cardiomyopathy, the oncology patients whose treatment was cardiotoxic. It's a very complicated field and no one expects a new-to-the-specialty nurse to know it all.

[mysonsmama]

I know they don't expect me to walk onto the floor knowing it all, or maybe anything. However, this unit has had difficulties with hiring new grads and them being too "deer in the headlights" and not grasping the knowledge. I'm hoping to walk in with at least a little info in my brain so I have something to build upon.

And I am so thankful for the above posts! They have already given me a lot to work on =D

[NotReady4PrimeTime, RN]

You're SO welcome! I have to say that I've seen my share of "deer-in-the-headlights" new grads, but I've also seen a lot (LOT!) of overconfident know-it-all new grads too. (Funny how a couple of those just leap to mind.) Having at least a basic understanding of what you're embarking on is a great idea. When you ask intelligent questions and admit when you're overwhelmed, you'll be ahead of the rest. Good for you!

[MGMR]

As a new grad just off orientation in a Pediatric CVICU, I'll add my two cents!

For me, it was overwhelming trying to master all the defects at once. I found it best to wait until I had a patient who had a certain defect, and then study that defect in depth for a few days if possible. That way, I had a reference to think back to, and if I got another patient with the same or similar defect, it was almost like a review.

I would definitely know normal code doses (epi, calcium chloride, bicarb) what do for SVT (ice to the face etc), dosing of Joules for cardioversion and defib., and more pertinent things that are important to know in the moment if that makes sense. I found that it was easier to study pressures in the heart, interpreting ECGs, or defect anatomy in my (very little) free time and review it as it came along in future patients assigned to me. I don't think you'll be helping in a code situation anytime soon or anything like that, but personally I found that really knowing that type of information by heart was hard to do in the midst of panic if you didn't study it like crazy, and it isn't something you get to practice or see a lot like a patient with a VSD for example.

Aside from more pertinent information like I said, I would study medications, their indications and side effects you'd want to watch out for. For me, I would say to know Milrinone, Lasix, Nitroprusside, Precedex, Fentanyl/Morphine, Epinephrine, Prostin.

It's an amazing specialty and couldn't be more interesting honestly. I highly doubt they'll expect you to know everything, for me they were honestly surprised if I knew anything at all coming in as a new grad. Again, just my two cents!